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Endoscopy 2003; 35(11): 962-966
DOI: 10.1055/s-2003-43470
Original Article
© Georg Thieme Verlag Stuttgart · New York

Impact of Endoscopic Ultrasound Combined with Fine-Needle Aspiration Biopsy in the Management of Esophageal Cancer

K.  J.  Chang1 , R.  M.  Soetikno1 , D.  Bastas1 , C.  Tu1 , P.  T.  Nguyen1
  • 1 Dept. of Medicine, Division of Gastroenterology, Gastrointestinal Oncology Section and Dept. of Radiological Sciences, University of California, Irvine Medical Center, Orange, California, USA
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Publication History

Submitted 11 March 2002

Accepted after Revision 20 June 2003

Publication Date:
07 November 2003 (online)

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Background and Study Aims: Endoscopic ultrasound (EUS) in combination with fine-needle aspiration biopsy (FNA) is a highly accurate method for the preoperative staging of esophageal cancer. Its impact on medical decision-making and the cost of care is unknown. This prospective case series was undertaken in order to determine the impact of EUS in combination with FNA on patients’ choice of therapy and on the cost of care.
Patients and Methods: Sixty consecutive patients with esophageal cancer, referred for preoperative EUS staging in a large tertiary-care academic medical center, were enrolled. The accuracy of EUS, the impact of EUS-based staging on the patients’ choice of therapy, and costs were studied.
Results: The accuracy rates for EUS combined with FNA in tumor and lymph-node staging were 83 % and 89 %, respectively. Twenty-five patients (42 %) had EUS stage I and II and were candidates for curative surgery. Twenty-eight patients (47 %) had stage III, and seven (12 %) had stage IV. All patients with stage I had surgery, while all patients with stage IV had medical therapy. The majority (62 %) of patients with stage II had surgery, while only a minority (25 %) of patients with stage III had surgery. Thirty-six patients (60 %) underwent medical therapy. Patients’ medical decisions in favor of surgical or medical therapy correlated strongly with the results of their EUS staging (P = 0.005), but not with age, sex, or referring physicians (surgeons vs. nonsurgeons). EUS-guided therapy potentially decreased the cost of care by $ 740 424 ($ 12 340/patient) by reducing the number of thoracotomies.
Conclusions: Patients’ decisions regarding therapy correlated with their overall tumor staging, suggesting that the information provided by EUS played a significant role in patients’ decision-making. The use of EUS in combination with FNA reduces the cost of managing patients with esophageal cancer.

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K. J. Chang, M.D.

Dept. of Gastrointestinal Oncology, Building 23, Route 81, University of California Irvine Medical Center

101 The City Drive · Orange · CA 92868 · USA

Fax: +1-714-456-7520·

Email: kchang@uci.edu